Biomarkers, social, and affective predictors of suicidal thoughts and behaviors in adolescents

描述(由申请人提供)：三分之一至一半的精神病住院青年再次入院，出院后15-30天再入院风险最高，80%以上在三个月内再次入院。这项拟议的研究涉及使用生态学方法和设备对青少年出院后与自杀风险相关的自然现象进行活体表征，这些方法和设备允许对个人的社会环境进行声学捕捉，并自我报告经历过的情感。我们认为，社会背景和经历过的情感是相互促进的，一种包括紧张的社会密切耦合的反应性风格 情境(孤立、冲突或高情感互动)与情感反应(快速变化、强烈情感，缓慢回归基线)会增加自杀念头和行为的风险。我们还检查了儿童期虐待和表观遗传标记作为出院后反应性的预测因子。200名因自杀想法和行为住院的青年将在精神病出院后使用生态学方法和设备进行前瞻性跟踪调查三周；自杀想法和行为将在6个月后重新评估。本研究通过纳入影响反应生物标记物(用于评估DNA/dNaM/表达的住院血液样本)进一步创新。这项拟议的研究融合了多个研究领域，并允许对真实世界中情感和社会背景的相互作用进行创新和彻底的表征。这项调查的结果将为一些干预方法提供信息，包括家庭治疗、基于EMA的辅助干预和药理学方法。

DESCRIPTION (provided by applicant): One third to one half of psychiatrically hospitalized youth is readmitted, with highest readmission risk 15-30 days post discharge and more than 80% readmitted within three months. The proposed study involves in vivo characterization of naturalistic phenomena associated with suicide risk after discharge adolescents using ecological methods and devices that allow acoustic capture of an individual's social environment and self-reports of experienced affect. We propose that social context and experienced affect are reciprocally reinforcing and that a reactive style involving close coupling of stressful social context (isolation, conflictual or high affect interactions) with affect reactivity (rapidly changig, intense affect, with slow return to baseline) increases risk for suicidal thoughts and behaviors. We also examine childhood maltreatment and epigenetic markers as predictors of post-discharge reactivity. Two hundred youth hospitalized for suicidal thoughts and behaviors will be followed prospectively using ecological methods and devices for three weeks following psychiatric discharge; suicidal thoughts and behaviors will be reassessed at 6 months. The present study further innovates through the incorporation of affect reactivity biomarkers (in-hospital blood samples for assessment of DNA/DNAm/expression). The proposed study merges multiple fields of study and permits an innovative and thorough characterization of the real-world interplay of affect and social context. Results of this investigation will inform a number of intervention approaches including family therapy, EMA-based adjunctive intervention, and pharmacological approaches.